Bill > S499

Introduced Session

This bill provides for an improved system for eligibility determination for the Medicaid and NJ FamilyCare programs, implementing a recommendation of the New Jersey Health Care Quality Institute's report "Medicaid 2.0: Blueprint for the Future." Specifically, the bill requires the Commissioner of Human Services, in consultation with the Office of Information Technology, to develop an information technology platform for the intake, processing, and tracking of applications for benefits under the Medicaid and NJ FamilyCare programs. The goals of the system will be: to simplify the applications and eligibility determination processes for both applicants and eligibility determination staff; to standardize application of eligibility policy across the various agencies responsible for eligibility determination; to allow for real-time tracking of the status of applications; to allow the rapid exchange of data relevant to applications among various State and county agencies and contractors; and to provide a platform to expand the system to encompass other social service program applications and eligibility determinations as the technology permits. The bill also requires the commissioner to establish a system to evaluate the performance of all entities responsible for intake and processing of applications for the Medicaid and NJ FamilyCare programs, including all county welfare agencies and the State's contracted health benefits coordinator. The system will allow for the measurement of a set of relevant common metrics related to applications intake and eligibility determination. The commissioner will establish a system of rewards and penalties for all entities responsible for intake and processing of applications that provides incentives for performance on these metrics. This system will provide incentives for county welfare agencies to provide extended hours of operation for in-person intake of applications and information requests, and to provide in-person navigators to assist applicants with their applications when necessary. The system will further provide incentive for the use of administrative renewals that do not require a beneficiary to file a renewal application, when such administrative renewals are permissible under State and federal law and can be completed with information from tax records and clinical and financial determinations made by other public entities. Finally, the bill requires the commissioner to designate an ombudsperson to receive complaints that result from the eligibility application process. The ombudsperson will have authority to review all records of the cases about which complaints are submitted; to interview individuals who submit complaints, the individuals who have assisted with their applications, and the State and county staff who have worked on their cases; and to recommend corrective actions to State and county agencies to address specific complaints and reduce future complaints.

AI Summary

Committee Categories

JoAnn Downey (D)*,  Eric Houghtaling (D)*,  Fred Madden (D)*,  Joe Vitale (D)*,  Andrew Zwicker (D)*,  Pam Lampitt (D),  Angela Mcknight (D),  Gabriela Mosquera (D),  Cleopatra Tucker (D), 

Approved P.L.2019, c.246. (on 08/23/2019)